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Knee Braces - How to choose a proper fit

post #1 of 12
Thread Starter 

We've had several members talk about custom fitting knee braces after or during  medical procedures.  My question is, how tight should a knee brace be. 

 

Assuming that you don't want to cut off circulation, but you need it to be firm enough to support the knee. 

post #2 of 12
Quote:
Originally Posted by Trekchick View Post
 

We've had several members talk about custom fitting knee braces after or during  medical procedures.  My question is, how tight should a knee brace be. 

 

Assuming that you don't want to cut off circulation, but you need it to be firm enough to support the knee. 

 

I have nothing to back this up with (i.e. education) other than this is my opinion.

 

Just like your boots without the wiggle room for your toes.  It also depend on what type of brace you are talking about and why you wear it.  Most folks here I would guess use and ACL brace while others just want a little support/warmth/compression from a neoprene one.

 

On an ACL one, it should be snug but not constricting.  Most of the time, mine feels like my boots do; I can wear them all day without issue but I'm very happy when they come off.  I have made some modifications to mine and I don't always follow the "mounting" instructions in order, but I do make sure each and every time it is in the correct spot and feel right.  I then stand straight up and extend my leg to ROM and adjust the strap in the back above the knee so it doesn't constrict.  Usually after surgery, there is a "stop" in the hinge so you can't go past 90% straight.  It's to protect the new acl from hyper-extending and/or your meniscus if you don't have an acl.  I reset my to 0 so I can get 100% extended, but I'm not wearing it to protect and acl.  I'm using it for support to prevent swelling.  It is more of an exoskeleton.  I'm still not sure why (believe it is my meniscus) but too much pounding and my knees swell.  I wear compression tights and the braces and my knees are fine. 

 

I think the tightness also depends on muscle mass of the leg.  I'm not sure but I would suspect that a leg on a body with a low BMI would fit in a brace differently to a high BMI to get the same effect.  Again, this is speculation.

 

The other critical thing to watch, is that the hinge is in the correct location.

 

Hope this helps,

 

Ken

post #3 of 12
I have severe OA. I spoke with my ortho about getting an unloader brace. His opinion was that most patients don't wear them tight enough to be effective.
post #4 of 12
Quote:
Originally Posted by Trekchick View Post

We've had several members talk about custom fitting knee braces after or during  medical procedures.  My question is, how tight should a knee brace be. 

Assuming that you don't want to cut off circulation, but you need it to be firm enough to support the knee. 

I don't think knee braces should ever be self-prescribed, so my answer is, ask the professional who prescribes it.

Elsbeth
post #5 of 12

I have just gotten the new DONJOY ACL/MCL fitted for me. It took about 2 weeks to be made. Insurance pays for most of it every 2-3 years. This new brace although over 1g is by far the most comfortable I have ever had. You always know its there but not nearly as constricting, pinchy, or make your legs go numb because you have to tighten it so tight to stay in place. I also rope calves and this new brace does not rub on my saddles. Go to your Dr. and have one fitted if it is it will stay in place and you dont have to cinch it down. I've had several Lennox Hill, DonJoy etc... By far DONJOY is the best I've had for ACL recon, and Stability. Mine has springs that slow my leg from over extending and stops that keep my knee 4/6 deg from 180 deg or straight. This is proscribed by my Dr. not my decision. DONJOY braces Rock.

Bo

post #6 of 12

I have a Bledsoe brace. It comes with a neoprene sleeve you wear underneath the brace for compression & to reduce irritation. The brace also has padding on the inside. I just tighten it enough so the brace is snug. The nice thing about the brace is the bottom of it rests right on the top of my ski boots so I don't have to worry about it slipping down. I've worn it for 8 days skiing so far & have been happy with it.

post #7 of 12
Quote:
Originally Posted by SHREDHEAD View Post

I have severe OA. I spoke with my ortho about getting an unloader brace. His opinion was that most patients don't wear them tight enough to be effective.

I use one and it works well.  Without it I couldn't ski at all.

 

I think it was about 1000.00.  Worth every penny IMO.

post #8 of 12

Nice, I have wondered how that would work. I have purposefully bought shorter boots so they wouldn't ride one the top of my boot. I might have to change that thinking and give the taller boot a try. The one problem I have after the recon, is that I tend to ride back on my skis way more than I did before. so instead of carving I pushing or skidding my skis. SUCKS. I have been told to buy a taller more forward boot and now with the insite of you riding your brace on the top of your boot I feel like Ive got options. I going to the hill Thursday I think Ill stop in a shop and demo a few sets of new taller boots. Thats exciting new you have give me. I dont know why I had it in my mind that I shouldn't do it your way. Ive never been told not to do that. Somewhere along the way I just decided it would not work. I'm cant wait to get to the boot stors. Thanks for the input. AWESOME HELP!!!!

Also have you ever put wedges under your footbed to make yourself get more forward? I am also going to try a 1/8" - and 3/16" wedge under the heel to see if that helps me. The good thing is if it does nt work I just pull em out. When I do it in a miror not on skis just boots my arm pits move over my knees in a strong tuck position. Any suggestions you might have for this would be appreciated if you've ever with through this back seat problem. I'm sure its coming from my not believing my knee is strong enough to push it. Hence Im sitting back. Mind games with the new leg take a while to get over. took 4 years to trust my last ACL replacement. the graft was great but I finally quit wearing the brace roped a calf one day stepped off my horse in a divot on the side of my heel go 25+mph I straight legged it . Soon s I did it I knew I had trouble. Hyperextended backwards and outwards 4"-6". Ouch. I wqs done for another year. So onw starting over I hae no faith in the new graft yet or strength of the knee. So I ride back like a sissy. So i guess Im looking for trick that will make me get up on my skis so I dont have a choice. Either go or quit.

Once again thanks for your input. Gonna give it a try brother!!!! MErry christmas. and lots of POW to you.

Bo

post #9 of 12
Bo,
Good on ya for chasing this but it sounds like you might going in a wrong direction. Some of the things that jump out at me are; looking for a boot to hold the brace up and using heel lifts to get forward.

When I first started wearing a brace I had a taller boot and it wouldn't let the brace slide down. I thought this was great and convenient, but it also enabled me to not pay as close attention to how I put the brace on. If you wear the brace correctly, it won't slide down.

Both the boot and brace have specific jobs and need to work independently. They aren't a system and both need to be fitted properly for their intended performance. The boot is the most important part of your ski gear and the fit is the most critical. The height of hype boot should be based on your anatomy and not where the bottom of the brace is.

With regards to using heel lifts, I think heel lifts have their place, but they aren't usually used to get you forward. Consider when a women wears high heels or you put on work or cowboy boots. Anyone wearing those doesn't lean more forward. Often, toe lifts are used to get you more forward. Heel lifts actually cause you to open your ankle not close it.

I really thing the thing that would help you most with getting forward is for you to change your thinking. I went through it too - twice. After each knee surgery I became more defensive and skied that way and it is the complete opposite thing to do with regards to safety. If you weren't previously in the back seat and are now, it is your technique and thinking that has to change and not your gear.

What worked for me was going back to the basics and lots of training. Yes instructors/coaches train all the time. Probably more so than any other demographic outside of race kids.

It's good to experiment and try different things to figure this out. A good boot fitter can help as can lessons from someone that understands what you are going through.

Happy Holidays,

Ken
post #10 of 12

Dang Ken, I sure appreciate your thoughts, Your right I'm looking for excuses and need to get with a coach for my technique.

 

As you said My brace fits and has been fitted so it doesn't move on my leg.fitts great and comfortable. As you know from your knees it a terrible mind game you play. I find myself over compensating with my other leg while hiking. Even just going up or down stairs I lead with my stronger leg. Always. Subconsiencely always protecting the damaged leg. Heck look a Lindsey Vohn and what she is going through. Guarantee you it just what you and I are and have gone through. 

 

I am going to do just as you said as it makes the most sense. I going to have a day or two of coaching and get his thoughts and take those to the bootfitter if he says a change might be needed. Ill bet he just gets me comfortable and it'll all sort it's self out. 

 

Thank you for your input Brother. Really nice to hear thoughts from someone who has been there and done it. It's just a mind game otherwise. 

 

Merry Christmas to you my friend.

 

Bo

post #11 of 12
Quote:
Originally Posted by Trekchick View Post
 

We've had several members talk about custom fitting knee braces after or during  medical procedures.  My question is, how tight should a knee brace be. 

 

Assuming that you don't want to cut off circulation, but you need it to be firm enough to support the knee. 

depends on the type of brace.

 

If we are talking about off the shelf, sports store, type braces follow the instruction of the manufacturer.

 

Sport specific braces should be prescribed by your ortho doctor, they will size them up for you. Same goes for custom braces but these will be actually molded to your leg.

 

Most important thing is not go and buy something one doesn't fully understand. there are many different types of braces made for very specific conditions. getting a neoprene hinged brace for an ACL injury won't do you any good. just as an ACL brace won't help with your OA.

post #12 of 12
Knee braces are worn around the knee joint to provide support to knees.How much tight we should kept it, this depends upon injury and degree of protection required.
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